Risk factors for a suboptimal immune response to SARS-CoV-2 vaccination in liver transplant recipients

Background Liver transplant (LT) recipients frequently show no or low response after two SARS-CoV-2 vaccinations. However, the relevance of different clinical risk factors (RF) for a suboptimal response is still unanswered.

Methods Anti-SARS-CoV-2 antibody titers of 141 LT patients determined after the second vaccination assigned them to low ( < 100 BAU/ml) or high response. The relevance of previously identified clinical RF for low response (diabetes, chronic kidney injury, hypertension or age > 65y) and antiproliferative immunosuppression were now analyzed in detail.

Results The full clinical data set was available in 101 patients (55 low, 46 high responders). In total, 82% of low and 52% of high responders had one or more clinical RF. The risk of low response for patients having at least one, two or three clinical RF increased from 31% (N=10 of 32) to 65% (N=45 of 69), 86% (N=32 of 37) and 93% (N=13 of 14), respectively. If all four RF were present, the risk of low response increased to 100% (N=6 of 6). Also, a more frequent use of MMF or mTOR-inhibitors was detected in low responders (74%) compared to high responders (37%). Of the 26% (N=12) of low responders not receiving antiproliferative immunosuppression the majority had one (25%) or more (50%) clinical RF.

Conclusion If clinical RF are present, the risk of low SARS-CoV-2 vaccination response increases 1.6-fold and with the number of RF. These data can help to identify patients under immunosuppression with the highest risk of suboptimal response to further SARS-CoV-2 vaccinations.

Publikationsverlauf

Artikel online veröffentlicht:
26. Januar 2022